Healthcare Provider Details

I. General information

NPI: 1295406247
Provider Name (Legal Business Name): ALTUM HOME CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6155 S FLORIDA AVE STE 15A
LAKELAND FL
33813-3323
US

IV. Provider business mailing address

908 S FLORIDA AVE STE 206
LAKELAND FL
33803-1177
US

V. Phone/Fax

Practice location:
  • Phone: 630-755-1653
  • Fax:
Mailing address:
  • Phone: 630-755-1653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: RUFINO LUGOD JR.
Title or Position: OWNER/PRESIDENT/ADMINISTRATOR
Credential:
Phone: 630-755-1653